This invention is in the area of methods for the treatment of human immunodeficiency virus (also referred to as “HIV”) that includes administering to a host in need thereof, either alone or in combination, an effective HIV-treatment amount of one or more of the active compounds disclosed herein, or a pharmaceutically acceptable prodrug or salt of one of these compounds.
In 1981, acquired immune deficiency syndrome (AIDS) was identified as a disease that severely compromises the human immune system, and that almost without exception leads to death. In 1983, the etiological cause of AIDS was determined to be the human immunodeficiency virus (HIV).
In 1985, it was reported that the synthetic nucleoside 3′-azido-3′-deoxythymidine (AZT) inhibits the replication of human immunodeficiency virus. Since then, a number of other synthetic nucleosides, including (−)-β-2′,3′-dideoxy-3′-thiacytidine (3TC), β-2′,3′-dideoxy-3′-thia-5-fluorocytidine (FTC), 2′,3′-dideoxyinosine (DDI), 2′,3′-dideoxycytidine (DDC), and 2′,3′-dideoxy-2′,3′-didehydrothymidine (D4T), have been proven to be effective against HIV. After cellular phosphorylation to the 5′-triphosphate by cellular kinases, these synthetic nucleosides are incorporated into a growing strand of viral DNA, causing chain termination due to the absence of the 3′-hydroxyl group. They can also inhibit the viral enzyme reverse transcriptase.
The success of various synthetic nucleosides in inhibiting the replication of HIV in vivo or in vitro has led a number of researchers to design and test nucleosides that substitute a heteroatom for the carbon atom at the 3′-position of the nucleoside. European Patent Application Publication No. 0 337 713 and U.S. Pat. No. 5,041,449, assigned to BioChem Pharma, Inc., disclose racemic 2-substituted-4-substituted-1,3-dioxolanes that exhibit antiviral activity. U.S. Pat. No. 5,047,407 and European Patent Application Publication No. 0 382 526, also assigned to BioChem Pharma, Inc., disclose that a number of racemic 2-substituted-5-substituted-1,3-oxathiolane nucleosides have antiviral activity, and specifically report that the racemic mixture of 2-hydroxymethyl-5-(cytosin-1-yl)-1,3-oxathiolane (referred to as BCH-189) has approximately the same activity against HIV as AZT, with little toxicity. The (−)-enantiomer of the racemate BCH-189, known as 3TC, which is covered by U.S. Pat. No. 5,539,116 to Liotta et al., is currently sold for the treatment of HIV in humans in the U.S. in combination with AZT.
It has also been disclosed that cis-2-hydroxymethyl-5-(5-fluorocytosin-1-yl)-1,3-oxathiolane (“FTC”) has potent HIV activity. Schinazi, et al., “Selective Inhibition of Human Immunodeficiency viruses by Racemates and Enantiomers of cis-5-Fluoro-1-[2-(Hydroxymethyl)-1,3-Oxathiolane-5-yl]Cytosine” Antimicrobial Agents and Chemotherapy, November 1992, pp. 2423-2431. See also U.S. Pat. Nos. 5,210,085; 5,814,639; 5,728,575; 5,827,727; 5,914,331; WO 91/11186 and WO 92/14743.
WO 96/40164 filed by Emory University, UAB Research Foundation, and the Centre National de la Recherche Scientifique discloses a number of β-L-2′,3′-dideoxynucleosides for the treatment of hepatitis B.
WO 95/07287 also filed by Emory University, UAB Research Foundation, and the Centre National de la Recherche Scientifique discloses 2′ or 3′ deoxy and 2′,3′-dideoxy-β-L-pentofuranosyl nucleosides for the treatment of HIV infection.
WO96/13512 filed by Genencor International, Inc., and Lipitek, Inc., discloses the preparation of L-ribofuranosyl nucleosides as antitumor agents and virucides.
WO95/32984 discloses lipid esters of nucleoside monophosphates as immunosuppresive drugs.
DE4224737 discloses cytosine nucleosides and their pharmaceutical uses.
Tsai, et al., in Biochem. Pharmacol. 48(7), pages 1477-81, 1994 discloses the effect of the anti-HIV agent 2′-β-D-F-2′,3′-dideoxynucleoside analogs on the cellular content of mitochondrial DNA and lactate production.
Galvez, J. Chem. Inf. Comput. Sci. (1994), 35(5), 1198-203 describes molecular computation of β-D-3′-azido-2′,3′-dideoxy-5-fluorocytidine.
Mahmoudian, Pharm. Research 8(1), 43-6 (1991) discloses quantitative structure-activity relationship analyses of HIV agents such as β-D-3′-azido-2′,3′-dideoxy-5-fluorocytidine.
U.S. Pat. No. 5,703,058 discloses (5-carboximido or 5-fluoro)-(2′,3′-unsaturated or 3′-modified) pyrimidine nucleosides for the treatment of HIV and HBV infection.
Lin, et al., discloses the synthesis and antiviral activity of various 3′-azido analogues of β-D-nucleosides in J. Med. Chem. 31(2), 336-340 (1988).
In light of the fact that acquired immune deficiency syndrome and AIDS-related complex have reached epidemic levels worldwide, and have tragic effects on the infected patient, there remains a strong need to provide new effective pharmaceutical agents to treat these diseases that have low toxicity to the host.
It is an object of the present invention to provide a compound and method for the treatment of human patients or other host animals infected with HIV.